title: Repeat endoscopic ultrasound-guided fine needle aspiration for solid pancreatic lesions at a tertiary referral center will alter the initial inconclusive result.
abstract: OBJECTIVE
  Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is indispensable for the diagnosis of solid pancreatic lesions (SPLs). However, initial attempt of EUS-FNA can be inconclusive. We retrospectively evaluated the ability of repeat EUS-FNA at a tertiary referral hospital to obtain a conclusive cytological diagnosis after the initial inconclusive EUS-FNA results at referring facilities.
  
  
  METHODS
  We identified patients who had undergone EUS-FNA for SPLs and with inconclusive cytological diagnosis at referring facilities. The diagnostic ability of EUS-FNA was defined as the percentage of cases with conclusive cytological diagnoses out of the total included cases in which initial results had been inconclusive. As a secondary outcome, we conducted sub-group analysis to reveal factors which might have assisted conclusive results at the University of Texas MD Anderson Cancer Center (MDA).
  
  
  RESULTS
  We found 913 patients who underwent EUS-FNA for SPLs between 2005 and 2011. Among them, we recruited 84 patients who met the above criteria. Repeat EUS-FNA had ability to clarify the diagnosis in 82.1 % (69/84). No statistical differences were observed in tumor size (n = 50, 29.8 versus 29.4 mm, P-value = 0.84) and the number of needles passes (n = 40, 4.0 versus 3.4, P-value = 0.1) between outside MDA and MDA. Rapid on-site evaluation was present in less than half of cases outside MDA (n = 33, 42.4 versus 100%, P-value = 0.0001). MDA endosonographers had more years of experience compared to outside MDA (n = 50, 12.9 versus 10 years, P-value = 0.015).
  
  
  CONCLUSIONS
  A repeat EUS-FNA for SPLs with initial inconclusive diagnosis at a tertiary referral center establishes a diagnosis in the majority of patients.
authors.affiliation: Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Rei
authors.initials: R
authors.lastname: Suzuki
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Lee
authors.forename: Somashekar Gopala
authors.initials: SG
authors.lastname: Krishna
authors.forename: Srinivas
authors.initials: S
authors.lastname: Ramireddy
authors.forename: Wei
authors.initials: W
authors.lastname: Qiao
authors.forename: Brian
authors.initials: B
authors.lastname: Weston
authors.forename: William A
authors.initials: WA
authors.lastname: Ross
authors.forename: Manoop S
authors.initials: MS
authors.lastname: Bhutani
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D002983:Clinical Competence; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000473:pathology*; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D013781:Texas